Residential Lien Questionnaire

A mechanic’s lien on a residential 1-family house, or 1-unit condo or co-op, must be filed with the County Clerk’s office within four (4) months from the last date work was performed or materials were provided. 2-family is eight (8) months. To file your lien, fill out the this lien questionnaire and hit “send form”.

Name of Your Company

Contact Name

First Name

Last Name

You will receive your lien via email

Your Business Address

(No PO Boxes)

Your Phone #

(###)

###

####

Full name of person signing lien

First Name

Last Name

Title of person signing lien

Name of contractor that hired you

Address of contractor that hired you

Name of prime contractor

(If you are a sub to a subcontractor)

Address of prime contractor

(if you are a sub to a sub-contractor)

Jobsite Address

The exact address where you did the work

County in which work was performed

Name of property owner

Address of the property owner

Describe the labor performed

Describe the materials provided

Describe the materials manufactured that were not put in the job

The agreed price and value of the labor performed (include both paid and unpaid labor)

The agreed price and value of the materials provided (include both paid and unpaid materials)

Total agreed price and value of the contract

The amount unpaid for labor performed

The amount unpaid for materials provided

The amount unpaid for materials manufactured but not delivered

What is the total amount of lien?

First date you performed labor

YYYY

First date you provided materials

YYYY

Last date you performed labor

YYYY

Last date you provided materials

YYYY

Residential Lien Questionnaire

Leonard J. Catanzaro | Attorney at Law